Bulletins

December 2003

This Bulletin is forwarded to every medical practitioner in the province. Decisions of the College on matters of standards, amendments to Regulations, guidelines, etc., are published in Bulletins. The College therefore assumes that a practitioner should be aware of these matters.

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Officers and Councillors 2003-2004

President - Dr. Rudolph Stocek, Hartland
Vice-President - Dr. Douglas Brien, Saint John

Dr. Jean-Marie Auffrey, Shediac
Ms. Barbara Bender, Saint John
Dr. Zeljko Bolesnikov, Fredericton
Dr. Marc Bourcier, Moncton
Dr. Terrance E. Brennan, Fredericton
Dr. Mary E. Goodfellow, Saint John
Dr. François Guinard, Edmundston
Dr. Paula M. Keating, Miramichi



Registrar - Dr. Ed Schollenberg


Mr. Stanley Knowles, Miramichi
Mr. Eugene LeBlanc, Dalhousie
Dr. John McCrea, Moncton
Dr. Marc Panneton, Campbellton
Dr. Robert E. Rae, Saint John
Dr. Beatriz Sainz, Oromocto
Dr. Malcolm Smith, Tracadie-Sheila
Dr. Claudia Whalen (PhD), Fredericton


At its meeting on 28 November, 2003, Council considered the following matters:

ANNUAL FEES

By now, all physicians should have received invoices for annual fees for their own licenses, as well as for their professional corporations. If this is not the case, physicians should contact the College office immediately. Physicians are reminded that if dues are no received by January 2nd, 2004, suspension of the license may occur immediately.

COMPLAINTS
There was a complaint regarding the results of an orthopedic procedure. The patient had a well-known complication which can occur despite appropriate care. In this case, based on expert opinion, the Committee could find no fault with the care provided by the surgeon.

There was a complaint that a physician had made comments to a patient which the patient felt crossed the line of appropriate physician/patient conduct. The physician denied the comments or felt they were misinterpreted. The Committee noted that the events had occurred at least six years earlier and, at this point, there was no way to verify the concerns. For that reason, the Committee did not feel it could take further action.

There was a complaint that a physician had failed to make a timely diagnosis of a mouth tumor. In reviewing the matter, the Committee noted that the physician had initially assessed the matter as an infection, but within a short time had reassessed the patient and referred him to a surgeon. The Committee could find no fault with the care provided.

A patient complained that a physician had failed to make a timely diagnosis of an ovarian tumor. The patient had first presented with non-specific symptoms. The physician had ordered investigations, but not on an urgent basis. The next day, the patient presented to the Emergency Department with severe pain which was investigated at that time. The Committee noted that these events had occurred several years ago and the patient had expressed no concerns at that time. Furthermore, the patient continued to see the physician after the incident. Based on the specific facts, the Committee could find no fault with the care provided by the physician.

There was a complaint that a physician had inappropriately disclosed confidential information in the course of a legal proceeding. The physician stated that the document in question was inadvertently included with some material submitted by his lawyer. He denied that it was intentional. Without evidence to the contrary, the Committee could not find any intentional breech of confidentiality.

A patient complained that she was improperly discharged from a physician's practice for failing to pay an invoice relating to missed appointments. She firstly noted that it was impossible to contact the physician's office to advise of the inability to attend an appointment. She also noted that she was not advised in advance of any charge for such missed appointments. Finally, she did not believe that questioning the invoice should be sufficient grounds to be discharged from the practice. In response the physician stated that an answering machine was available after hours and asserted there were other reasons that the patient was discharged. In reviewing the matter, the Committee noted several factors which are required under College guidelines in this circumstance. Firstly, there must be clear communication regarding any office policy for missed appointments. Secondly, the patient must know how to advise the office of the inability to attend. In this case, investigation disclosed that the physician did have an answering machine available, but there was no advice to callers to leave messages relating to cancelled appointments. Furthermore, the telephone system used during the day made it very difficult for patients to communicate with the staff or leave a message. Given those facts, the Committee did not feel the charges were appropriate. Even if they had been, the Committee questioned whether the dispute over the invoice was sufficient grounds to discharge the patient. When there is an outstanding invoice, denial of care is a poor way to enforce it. Such may generate a complaint and seldom causes the bill to be paid. Physicians are referred to the Physician Guide to Direct Billing, from the Medical Society, regarding the appropriate legal means for collecting on invoices.

There was a complaint that a physician had denied access to his practice to patients over a particular age. In response the physician admitted restricting access to his practice on this basis, but denied any improper conduct. As a consequence, the Committee recommended that the allegation of improper discrimination be referred to a Board of Inquiry. This was approved by Council.

>REVIEW COMMITTEE
There was a complaint that a physician had failed to cooperate with Atlantic Provinces Medical Peer Review, as required under the Medical Act. In the course of reviewing the matter, the physician accepted a further assessment of his office practice, which was satisfactory. The physician also acknowledged that it was his professional responsibility to cooperate with the Peer Review process. On that basis, and satisfied that the physician was practising at an appropriate level, the Committee determined to take no further action on the matter.

>OTHER BUSINESS